About Ben Glover

Engineering student at Melbourne University. Particularly interested in coding and how new technologies are changing the world of healthcare.

Melanoma. And the stages of Cancer.

Melanoma is a type of skin cancer that develops from our melanocytes, the melanin producing cells located in the bottom layer of our skin. Unfortunately, it is also the most deadly form of skin cancer killing 1,200 Australians every year.

On average, 30 Australians are diagnosed with melanoma every day. When a cancer is first diagnosed, it must be categorized so appropriate treatment can be provided. To achieve this, a biopsy of the lesion is taken by your GP, dermatologist or surgeon and the results used to determine which ‘stage’ the cancer is in.

The properties that doctors look for are known as TNM principles, which are as follows:

T: The size/location of the tumor or how much it has grown into nearby tissues.

N: Describes whether the cancer has been found in the lymph nodes and even how many of these lymph nodes contain cancer.

Lymph nodes are small oval shaped organs which are distributed throughout our bodies and are a key part of our immune system.

M: Has the cancer metastasized to other parts of the body? Metastasis is where a cancer spreads to another body part or organ not directly connected to the cancer’s origin.

Each of these factors combined determines the stage of the cancer. The TNM factors have to be considered directly in relation to the specific cancer being treated, meaning the staging for each cancer is unique. In general, the cancer stages go from 1 to 4, however some cancers such as melanoma also have a stage 0. Many melanoma stage categorizations can be very detailed and specific, so this is just a general overview:

Note: A melanoma with an ulceration is considered more dangerous and is likely to be staged more maturely.

Stage 0: The lesion is limited to the top layer of the skin and can be surgically removed fairly easily

Stage 1: The melanoma is between 0-2mm thick. The melanoma has still not metastasized and/or spread to the lymph nodes. The lesion is surgically removed.

Stage 2: The tumor is between 1-4mm thick with or without ulceration. The lesion is surgically removed and potentially any nearby lymph nodes.

Stage 3: The melanoma has spread to one or more lymph nodes or into the blood stream. Other small tumors may be found under the skin no more than 2 centimeters away from where the cancer first started.

Stage 4: The cancer has metastasized

Overall, the earlier the stage upon diagnosis, the more easily it can be treated, as it is smaller and more contained. This is why it is so important to complete regular spot checks at home using the ABC’s of melanoma and to see a doctor if you see anything suspicious.

Even movie stars get skin cancer – the Hugh Jackman story

If you followed the lead up to the launch of the movie X-Men: Days of Future Past you might be wondering why the actor behind the invincible Wolverine has been wearing a bandage on his nose?

Widely loved Australian actor Hugh Jackman has had a basal-cell carcinoma removed from his nose in May this year. This was in fact his second bout of cancer after a similar growth was removed also from his nose in November 2013. Luckily for Jackman and X-Men fans, a basal cell carcinoma is only life threatening in exceedingly rare cases as it rarely spreads beyond the original tumor site. It is also a slow growing form of skin cancer, but can have complications if it is allowed to grow large enough.

As Hugh Jackman has said “The beauty of all this is that it’s all preventable. It’s just about getting proper check-ups” and the actor is now pleading with people to wear sunscreen. Whilst the actor has recovered from the procedure, he is realistic about the future and aware that he’ll “have at least one more but probably many more”. He says that growing in Australia he doesn’t remember ever being told to put sunscreen on and believes this is largely the reason for his recent problems.

Given his level of influence, Hugh Jackman hopes that he will have more luck in convincing people to wear sunscreen than someone’s parent, wife, or husband. Hugh Jackman is a great example of how we all, no matter our status, are vulnerable to the effects of too much time in sun without proper protection.

Tanning not so cool anymore

With summer approaching, in face of the obvious health risks, you may see people begin to flock to the beach to work on their suntan. If you were to ask people’s opinions and preferences related to sun bathing, you would get a divided response. With increased awareness of health issues many people vouch for the health benefits of being sun smart, while others will still readily lie in direct view of the sun all day.

While sun tanning is quite a common activity in 2014, it may be surprising to know that this is a relatively new trend in human history. You’d have to look back to the 60’s to learn how sun tanning became part of western culture. The seamless sun tan had become iconic of female celebrities and film stars such as Brigitte Bardot and was representative of a life of leisure and a rebellion against social norms of the past. It was seen as a signal that such a woman was in control of her own body. However, what began as a minor attitude shift, soon became a full-fledged craze.

With all corners of the media projecting the sun tan ideology, adults and teenagers everywhere were now attempting to imitate what they saw in celebrity clad magazines. To make things worse, technology soon caught up to supply a market for customized and on-demand tanning, and with this the sun-bed was born, a device capable of increasing someone’s risk melanoma by 59% if they are under the age of 35 at the time of use. With tanning beds housed in glamorized ‘salons’, continued celebrity endorsement, and effective marketing, the industry became big business. The claim that a tan gives you a “healthy glow” was and still is central to the marketing tactics of these salons.

The main consequence following the post 60’s craze was a dramatic increase in skin cancers, especially in Australia, which has the highest incidence and mortality rates in the world. This trend has become a big concern for lots of people and has a once again begun to change our perception of the suntan. Unlike Brigitte Bardot, many of today’s female celebrities, including Victoria Beckham and Nicole Kidman have explicitly abandoned the bronzed look, instead choosing to promote their natural colour. The glamour and prestige attached to the tanned look is fading fast, as women are choosing to go with their own natural glow.

Studies show that this downward trend is alive and well across the Australian population. With the number of teenagers preferring a suntan dropping 15% from 2004 to 2011 and 22% amongst adults in the same time period.

Further studies in the area of UV exposure continue to reveal the disadvantages of sun tanning. In the attempt to achieve the seemingly youthful bronzed look, it turns out we are in fact contributing to the very ageing of our skin. Sunbathing breaks up the fibers that keep our skin looking firm and smooth, as a result, speed up the development of wrinkles, blotches, and freckles. Sunbathing to get a tan is certainly not so cool anymore.

The ABCDEs of melanoma

Of the many forms of skin cancer, melanoma is one of the most talked about because of its high mortality rates. Though only 2.3% of all skin cancers are melanoma, this condition contributes to 75% of all skin cancer deaths. That is the depressing news. The good news is that a large portion of melanoma related deaths are preventable. The key is early recognition and treatment, and by simply doing regular self-examinations at home this can be easily achieved.

Knowing what to look for during self-checks is all about the ABCDEs:

– Asymmetry: regular moles tend to have a regular shape (often circular), spots that are clearly asymmetrical should be taken note of and shown to a medical professional for assessment.

– Border: the borders of an early melanoma tend to be uneven, with notches and scallops potentially present as well.

– Colour: a multitude of different shades or colours present on the spot is a potential warning sign

– Diameter: most melanomas are greater than 6mm diameter when they are diagnosed, however just because a spot is smaller than this doesn’t mean the chance of melanoma is ruled out

– Evolving: any changes in the characteristics of a spot should be monitored. Things to watch for are changes can occur in size, colour, elevation and symptoms such as bleeding, itching, or crusting.

If you identify a lesion with some or all of these characteristics, you should see your GP as soon as possible. Lesions that itch, bleed, or don’t heal are also alarm signals.

While the ABCDE’s are a great for detecting the majority of melanomas, it is not so good for identifying the most dangerous form of melanoma called nodular melanoma. As a result, we should all also look for skin lesions that are:

  • Elevated above the skin
  • Firm to touch
  • Growing

Other non-malignant growths also exist that can show similar symptoms to a melanoma, such as seborrheic keratosis. Therefore, it is very important to seek professional medical advice to confirm any suspicions and to reach a diagnosis. When in doubt, check with your GP!

How does altitude affect UV?

There are a number of factors influencing how much UV we are exposed to as we are out and about, including altitude. There are a variety of reasons for this, including how the UV rays are absorbed by the ozone layer and amount of cloud cover. Please note the explanation that you are simply closer to the sun is not one of the reasons why altitude affects UV!

Before any further discussion, let’s remember that UV-B rays are the primary focus when thinking about the affects of altitude. UV-C rays are filtered out entirely by the ozone layer, while UV-A rays are basically unfiltered. Thus, it is the UV-B levels we care about here.

The majority of UV-B rays are in fact absorbed by the ozone layer. Most of the ozone layer subsides in the lower part of the stratosphere at around 20-30km above sea level. As a result, altitudes greater than 20-30km see much greater levels of UV-B. In fact UV-B levels are up to 350 million times higher at the top of the atmosphere than at the earth’s surface. These heights are greater than most people will ever go in their lifetime (Mount Everest stands at 7,200m above sea level and planes reach a maximum of 10,000-13,000m).

Below 20-30km, the general rule is that UV-B levels increase by 4% every 300m gain in altitude. A thinner atmosphere is the primary reason for this, as there are fewer particles to absorb UV. At low altitudes, the presence of tropospheric ozone (smog), aerosols, and other substances such as dust reduce the UV-B levels that reach the ground. These chemicals also become less dense as altitude increases.

Another side effect of high altitudes is changes in cloud cover. Clouds have the ability to reflect and scatter UV-B radiation. Typically clouds form anywhere between ground level and 18,000m high, with the cloud’s depth depending on its type. In general, the higher the altitude above ground level, the decreased likelihood of UV absorption by cloud cover. Mountains are an exception to this in that they tend to catalyze cloud formation above them for reasons relating to airflow and pressure. However, due to reflection from snowfall and a thinner atmosphere as mentioned earlier, mountaintops still tend to show much higher UV-B levels.

The bottom line here – altitude creates greater risk of skin damage secondary to higher UV-B levels. Be extra sun safe at high altitude!

How do I know what sunscreen to use?

“SPF.” “Broad spectrum.” “UV-A and UV-B.” “Water resistant.” “For sensitive skin.” The list of labels and things to consider when choosing a sunscreen goes on and on. Here we explain what to look for when selecting the right sunscreen for you.

The value of a sunscreen largely comes down to its active ingredients. Despite the generic use of the terms sunblock and sunscreen, there is in fact a difference between the two. A sunblock typically contains titanium dioxide or zinc oxide as its active ingredient, while a sunscreen generally includes other chemicals, such as parsol 1789, which absorb UV. While both sunblock and sunscreen provide effective skin protection, sunblocks are considered gentler on sensitive skin. Many sun lotions actually contain a mixture of sun block and sunscreen. Some ingredients to consider avoiding when choosing sunscreens/blocks include vitamin A, retinol, and retinyl palmitate, as there is evidence these chemicals may speed up the skin cancer sunscreen is designed to prevent.

Beyond active ingredients, it’s useful to consider SPF. An SPF factor can be found on all sunscreen bottles in Australia. SPF is calculated by comparing the amount of time needed to produce a sunburn on protected skin relative to unprotected skin. A SPF of 30 is generally recommended, as anything higher isn’t considered to provide significantly more protection. Please note SPF only relates to the blocking of UV-B rays (which cause sunburn) and not UV-A rays (which cause aging and some types of skin cancer). If you’d like to learn more about SPF, please see this blog post.[link to SPF blog]

Since none of us want to age faster than we have to, it’s a good idea to look for the ‘broad spectrum’ label when selecting sunscreen. By Australian law, ‘broad spectrum’ means protection against both UV-A and UV-B rays. Remember, SPF only refers to protection against UV-B rays. It is the UV-A rays that cause aging.

Another potential sunscreen feature that can be very useful is a form of water resistance. There are two related labels that can be found on Australian sunscreen bottles: “water resistant” and “very water-resistant.” Water resistant sunscreens should be reapplied every 40 minutes, while those claiming ‘very water-resistant’ should be reapplied every 80 minutes. Beware the skin care companies labeling their bottles as ‘water proof’, as no such thing exist. This is an important point – no sunscreens are truly waterproof. Recent law revisions are phasing these labels out because they are in fact only “very water resistant.”

 

What’s the deal with SPF?

SPF, or sun protection factor, is a term used to describe a products’ sun protection qualities. It represents the number of times longer a person who is wearing the protection can stay out in the sun without burning. For example, someone wearing sunscreen rated SPF 30 can expect to spend 30 times longer in the sun before being burnt when compared to having bare skin exposed.

Interestingly, SPF measures sunscreen’s ability to block UV-B rays, the type of UV that is attributed to sunburn. And to make this even more complex, the SPF value does not directly represent the amount of UV light that is blocked, as the scale is non-linear. For example:

-SPF 15 blocks 93% of UV-B rays

– SPF 30 blocks 97% of UV-B rays

– SPF 50 blocks 98% of UV-B rays

While SPF is a good way of representing the relative strength of sun cream, limitations exist. Firstly, UV-B rays are only one of three types of UV rays, the others being UV-A and UV-C. UV-C is not an issue for our health as they never reach the ground and are absorbed in the outer reaches of the atmosphere. UV-A causes aging of the skin and some types of skin cancer, but are not directly considered when the SPF is calculated. New laws in Australia do require the degree of UV-A ray protection to increase with increasing SPF in ‘broad spectrum’ sunscreens.

Despite all of this focus on SPF levels, it is actually the amount of sunscreen applied that largely dictates the level of sun protection achieved. To obtain the SPF as advertised, 1.5 milligrams per square centimeter of skin should be used or about 30 ml for total coverage.

Further, while high (50+) SPF sunscreens do marginally improve UV protection, the false sense of security they can provide often counteract their benefits. People who wear higher SPF sunscreens often spend longer in the sun and wear fewer other forms of protection, such as wide-brimmed hats.

Sunscreens are not the only products considered to have a sun protection factor. Clothes also offer sun protection with some typical SPF values seen in common clothing as follows:

  • Nylon stocking: 2 SPF
  • Hats SPF 3-6
  • Summer clothing – SPF 6.5
  • Sun protective clothing – up to SPF 30

Trust us on the sunscreen!

Whilst sunlight is essential in keeping our bodies in good health, too much sun can damage our skin, promote premature aging and wrinkles, and even cause cancer.

You may have heard that we need a daily exposure to sun to generate essential Vitamin D. However, only a short time in the sun is needed to get enough vitamin D- in fact, for many fair-skinned people, less than 15 minutes of sun exposure is required!

But 15 minutes is a very short time.  Most people easily spend more time than that outdoors.

Think of how long you last spent at the beach. More than a quarter of an hour?

How about at the pool?

How about taking the kids to sport?

Fortunately, sunscreen helps to reduce the amount of dangerous sun radiation that damages our skin, and reduces the risks of cancer and skin aging.

The thick, white, greasy pastes of the past put off many people from wearing sunscreen, but sunscreens have advanced in great leaps since the zinc creams of yore.

Newer sunscreen are available that are invisible, don’t leave a greasy feeling, and even last longer than before. Some makeup products are now combined with sunscreens, making it easier to look good and be protected at the same time!